Unit 2 Blood Components
Part 2
Terry Kotrla, MS, MT(ASCP)BB
Platelet Products
Platelets
• Used to prevent spontaneous bleeding or stop
established bleeding in thrombocytopenic patients.
• Prepared from a single unit of whole blood.
• Due to storage at RT it is the most likely component to
be contaminated with bacteria.
• Therapeutic dose for adults is 6 to 10 units.
• Some patients become "refractory" to platelet therapy.
• Expiration is 5 days as a single unit, 4 hours if pooled.
• Store at 20-24 C (RT) with constant agitation.
• D negative patients should be transfused with D negative
platelets due to the presence of a small number of
RBCs.
Preparation of platelet
concentrate
Plasma
RBCs PRP
Platelet
concentrate
Pooling Platelets
• 6-10 units transferred into one bag
• Expiration = 4 hours
Apheresis Platelet Concentrate
• One bag from ONE donor
• Need 6-10 for therapeutic dose
Apheresis Platelet Concentrate
• Used to decrease donor exposure, obtain HLA
matched platelets for patients who are refractory
to RD-PC or prevent platelet refractoriness from
occurring.
• Prepared by hemapheresis.
• One pheresed unit is equivalent to 5-6 RD-PC.
• Store at 20-24 C (RT) with agitation for 5 days.
• D negative patients should be transfused with D
negative platelets due to the presence of a small
number of RBCs
Apheresis
Apheresis
Apheresis Platelet Concentrate
• One bag (unit) from
one donor
• One unit is a
therapeutic dose
• Volume
approximately 250
ccs
Granulocytes
Lymphocyte Monocyte
Neutrophils Eosinophils Basophils
Granulocytes
• Primary use is for patients with neutropenia who have
gram negative infections documented by culture, but are
unresponsive to antibiotics.
• Therapeutic efficacy and indications for granulocyte
transfusions are not well defined.
• Better antimicrobial agents and use of granulocyte and
macrophage colony stimulating factors best for adults,
best success with this component has been with babies
• Daily transfusions are necessary.
• Prepared by hemapheresis.
• Expiration time is 24 hours but best to infuse ASAP.
• Store at 20-24 C.
Plasma Components
Fresh Frozen Plasma –
Volume 200-250cc
Fresh Frozen Plasma (FFP)
• Used to replace labile and non-labile coagulation
factors in massively bleeding patients OR treat
bleeding associated with clotting factor
deficiencies when factor concentrate is not
available.
• Must be frozen within 8 hours of collection.
• Expiration
– frozen - 1 year stored at <-18 C
– frozen - 7 years stored at <-65 C
– thawed - 24 hours
Fresh Frozen Plasma (FFP)
• Storage temperature
– frozen -18 C, preferably -30 C or lower
– thawed - 1-6 C
• Thawed in 30-37C water bath or FDA
approved microwave
• Must have mechanism to detect units
which have thawed and refrozen due to
improper storage.
• Must be ABO compatible
Pooled Plasma/Solvent
Detergent Treated
• Most recently licensed product.
• Prepared from pools of no more than 2500 units of ABO
specific plasma frozen to preserve labile coagulation
factors.
• Treated with chemicals to inactivate lipid-enveloped
viruses.
• Contains labile and non-labile coagulation factors but
lacks largest Von Willebrand’s factor multimers.
• Used same as FFP.
• Safety concerns
– Decreases disease transmission for diseases tested for.
– Doesn’t inactivate viruses with non-lipid envelopes: parvo virus
B19, hepatitis A, and unrecognized pathogens
Cryoprecipitated (AHF)
• Cold insoluble portion of plasma that precipitates when
FFP is thawed at 1-6C.
• Cryoprecipitate contains high levels of Factor VIII and
Fibrinogen, used for treatment of hemophiliacs and Von
Willebrands when concentrates are not available.
• Used most commonly for patients with DIC or low
fibrinogen levels.
• A therapeutic dose for an adult is 6 to 10 units.
• Can be prepared from WB which is then designated as
"Whole Blood Cryoprecipitate Removed" or from FFP
– Plasma is frozen.
– Plasma is then thawed at 1-6 C, a precipitate forms.
– Plasma is centrifuged, cryoprecipitate will go to
bottom.
– Remove plasma, freeze within 1 hour of preparation
Cryoprecipitate
(VIII, vW)
Thaw at 30-37°C
FFP Store at RT 4 hrs
Plasma cryoprecipitate, reduced
(TTP, FII, V, Vii, IX, X, XI)
Frozen Thawed Refrozen with 24 hrs of
within 8 FFP separation
Store at ≤18°C 1 yr
hours
5 day expiration at 1-6°C
Cryoprecipitate (CRYO), Factor VIII or
Anti-Hemophilic Factor (AHF)
• Storage Temperature
– Frozen -18 C or lower
– Thawed - room temperature
• Expiration:
– Frozen 1 year
– Thawed 6 hours
– Pooled 4 hours
• Best to be ABO compatible but not
important due to small volume
Cryoprecipitate – volume 15ccs
Irradiation of Blood Components
Irradiation of Blood Components
• Cellular blood components are irradiated to
destroy viable T- lymphocytes which may cause
Graft Versus Host Disease (GVHD).
• GVHD is a disease that results when
immunocompetent, viable lymphocytes in donor
blood engraft in an immunocompromised host,
recognize the patient tissues as foreign and
produce antibodies against patient tissues,
primarily skin, liver and GI tract. The resulting
disease has serious consequences including
death.
• GVHD may be chronic or acute
Irradiation of Blood Components
• Patients at greatest risk are:
– severely immunosuppressed,
– immunocompromised,
– receive blood donated by relatives, or
– fetuses receiving intrauterine transfusions
• Irradiation inactivates lymphocytes, leaving platelets,
RBCs and granulocytes relatively undamaged.
• Must be labeled "irradiated".
• Expiration date of Red Blood Cell donor unit changes to
28 days.
• May be transfused to "normal" patients if not used by
intended recipient.
Irradiation of Blood Components
Donor Blood Inspection and Disposition
• It is required that donor units be inspected periodically
during storage and prior to issuing to patient.
• The following may indicate an unacceptable unit:
– Red cell mass looks purple or clots are visible.
– Zone of hemolysis observed just above RBC mass, look for
hemolysis in sprigs, especially those closest to the unit.
– Plasma or supernatant plasma appears murky, purple, brown or
red.
– A greenish hue need not cause a unit to be rejected.
– Inspect platelets for aggregates.
• Inspect FFP and CRYO for signs of thawing, evidence of
cracks in bag, or unusual turbidity in CRYO or FFP (i.e.,
extreme lipemia).
Inspection of Donor Blood
• Segment closest to
unit is hemolyzed.
• May indicate bacterial
contamination
Donor Blood Inspection and Disposition
• If a unit's appearance looks questionable do the
following:
– Quarantine unit until disposition is decided.
– Gently mix, allow to settle and observe appearance.
• If bacterial contamination is suspected the unit should be
cultured and a gram stain performed.
• Positive blood cultures usually indicative of:
– Inadequate donor arm preparation
– Improper pooling technique
– Health of donor - bacteremia in donor
• If one component is contaminated, other components
prepared from the same donor unit may be
contaminated.
Inspection of Donor Blood
• Reissuing blood cannot be done unless the following
criteria is met:
– Container closure must not have been penetrated or entered in
any manner.
– Most facilities set 30" time limit for accepting units back, warming
above 6-10C even with subsequent cooling increases RBC
metabolism producing hemolysis and permitting bacterial growth.
– Blood must have been kept at the appropriate temperature.
– One sealed segment must remain attached to container.
– Records must indicate that blood has been reissued and
inspected prior to reissue.
• Platelets may be accepted after 30” if platelets still swirl
and no visible clumps, must agitate 10” before reissue.
Transportation of Blood and Blood
Components
• Shipping container used for transportation
must be validated to ensure proper
temperature is maintained.
– Place different numbers of units to transport in
container with coolant.
– Measure temperature frequently to determine
maximum number of units which can be
transported at one time and maintain
temperature.
Transportation of Blood and Blood
Components
• WB and RBC
– Sturdy well insulated cardboard and/or styrofoam
container, wet ice in ziplock bag or packaged coolant
to cool, temperature must be monitored.
– Mobile collection units should transport blood ASAP
and leave at RT if platelets are to be made.
– In-house transport place in cooler with wet ice or
packaged coolant and thermometer, monitor
temperature every 30 minutes.
Safe-T-Vue Temperature Monitor
Transportation of Blood and Blood
Components
• Frozen components
– Temperature must be maintained at or below required
storage temperature.
– Use dry ice in well insulated container.
• Platelets and granulocytes
– Maintain at 20-24 C.
– Transport in well insulated containers without ice.
• Commercial coolers available to maintain at 20-
24C.
Transportation of Blood and Blood
Components
• Handling donor units
– Should not remain at RT unnecessarily, when
blood is issued it should be transfused as
soon as possible.
– When numerous units are removed from
fridge, remove fluid filled container with a
thermometer at same time as blood, when
temperature reaches 6 C return to fridge.
Records
• Must be made concurrently with each step
of component preparation, being as
detailed as possible for clear
understanding.
• Must be legible and indelible.
• Must include dates of various steps and
person responsible.
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